Provider Demographics
NPI:1821078064
Name:WILTZ, KEVIN ANTHONY II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANTHONY
Last Name:WILTZ
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 LAKE EMMA RD UNIT 1000
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3358
Mailing Address - Country:US
Mailing Address - Phone:855-733-3126
Mailing Address - Fax:407-708-1834
Practice Address - Street 1:3200 LAKE EMMA RD UNIT 1000
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3358
Practice Address - Country:US
Practice Address - Phone:855-733-3126
Practice Address - Fax:407-708-1834
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS388821835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS38882OtherLICENSE NUMBER